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Priority Partners Coronavirus (COVID-19)

COVID-19 Testing

The following additional testing codes have been added:

Effective April 10, 2020, during the Public Health Emergency:

Antibody Testing

  • 86328: Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]). Reimbursement rate $45.23.
  • 86769: Antibody testing using multiple-step method; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]). Reimbursement rate $42.13.

Effective April 14, 2020:

  • U0003: Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R. Reimbursement rate $100.
  • U0004: 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R. Reimbursement rate $100.

Effective March 1, 2020:

  • G2023: Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source. Reimbursement rate $23.46.
  • G2024: Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source. These codes are billable by clinical diagnostic laboratories. Reimbursement rate $25.46.

Effective Feb. 4, 2020

  • Testing for COVID-19 is covered with an in-network or out-of-network provider.
  • Members have no cost-shares (copayments, co-insurance and deductibles) for COVID-19 testing per CDC guidelines and the COVID-19 testing related services for which payment may be made under Maryland Medicaid.
  • Prior authorizations waived for COVID-19 testing and COVID-19 testing related services for which payment may be made under Maryland Medicaid.
  • Reimbursement for CMS codes: U0001 ($35.92) or U0002 ($51.33) and AMA code 87635 ($51.33).
  • Priority Partners follows Maryland Department of Health guidelines—monitor the latest updates.

Prescriptions

  • Time restriction on refill removed to allow members to receive a refill of their medication.

In light of the COVID-19 Public Health Emergency, to help ensure appropriate access to needed medications, Quantity limit was added to certain medications on a temporary basis. Priority Partners will continue to evaluate as needed:

Drug NameDescription of Change*Copay AmountEffective Date of Change
ChloroquineQL added (10days supply/60days); N/A to FDA approved diagnosis$104/01/2020
HydroxychloroquineQL added (10days supply/60days N/A to FDA approved diagnosis$104/01/2020
Kaletra (Lopinavir-ritonavir)QL added (10days supply/60days); N/A to FDA approved diagnosis$304/01/2020
Azithromycin 250mg tabletsQL added (6 tablets/60 days)$104/01/2020
*QL = Quantity Limit
 

Telemedicine

  • Expanded telehealth services; MDH has temporarily expanded the definition of a telehealth originating site to include a participant’s home or any other secure location as approved by the participant and the provider for purposes of delivering Medicaid-covered services.
  • Traditional telehealth technology which meets all formal requirements is strongly preferred. (These services remain unaffected by the measures in this guidance).
  • If Medicaid participants are unable to access originating sites possessing fully qualified technology (ability to pan/focus camera, multiple views, etc.) this emergency policy will permit the use of notebook computers, smartphones, or audio-only phones.
  • If Medicaid participants cannot access cell-phone based video technology, audio only telephone calls will be permitted.
  • Read the full memorandum and the Addendum, which include details on covered services, distant sites, and billing guidelines.
  • PT/OT/Speech is covered. Please refer to EPSDT guidelines for enrollees under age 21.
  • Services provided through telehealth are subject to the same program restrictions, preauthorizations, limitations and coverage that exist for the service when provided in-person.
  • Members have no copayment or cost shares for telemedicine.

Well-Child Visits

View the Maryland Department of Health (MDH) Guidance on Well-Child Visits and Preventive Care During the COVID-19 State of Emergency. These changes are effective as of 3/5/2020 for Priority Partners and will remain in effect until the State of Emergency ends.

Priority Partners will also be covering the following additional telemedicine codes effective March 5, 2020 until the COVID-19 State of Emergency ends:

  • CPT 99201-99205: Office or Other Outpatient Visit for the Evaluation and Management of a New Patient.
  • CPT 99241-99245: Office or Other Outpatient Consultation Visit.
  • CPT 99386-99387: New Patient Preventive Medicine.

Telehealth Place of Service (POS) Codes

When providers bill for telehealth services with the -GT modifier, they should use the provider’s location when determining the appropriate POS code to bill. Permitted places from where to deliver services via telehealth include:

  • School (03)
  • Office (11)
  • Inpatient hospital (21)
  • Outpatient hospital (22)
  • Emergency room (23)
  • Nursing facility (32)
  • Independent clinic (49)
  • Federally Qualified Health Center (FQHC) (50)
  • Community mental health center (53)
  • Non-residential substance abuse treatment facility (57)
  • End-stage renal disease treatment facility (65)
  • Public health clinic (71)

Maryland Medicaid does not accept or use POS code 02 for telehealth. Providers working from a home office to provide services via telehealth should use POS 11 for office and not POS 12 for home.

Remote Patient Monitoring Services (RPM) Expanded during COVID-19

The Maryland Department of Health (MDH) is expanding the conditions that would qualify a participant to receive Remote Patient Monitoring (RPM) services to include all conditions capable of monitoring via RPM, not just chronic obstructive pulmonary disease (COPD), congestive heart failure, and diabetes. (COMAR 10.09.96.01(C), 10.09.96.05(A)(4))

The Department is waiving the current regulatory requirement limiting use of RPM services to participants with a history of hospital or emergency department utilization. (COMAR10.09.96.05(B))

During the state of emergency, participants with a condition capable of monitoring via RPM will be eligible for services even if they do not meet the following requirements:

  • Two hospital admissions within the prior 12 months with the same qualifying medical condition as the primary diagnosis;
  • Two emergency department visits within the prior 12 months with the same qualifying medical condition as the primary diagnosis; or
  • One hospital admission and one separate emergency department visit within the prior 12 months with the same qualifying condition as the primary diagnosis.

All other delivery of care and billing requirements for RPM services will remain in effect. Consistent with prior guidance, Medicaid will not pay for:

  • RPM equipment;
  • Upgrades to RPM equipment; or
  • Internet service for participants.

Prior guidance on RPM services is included below: